Oral acyclovir suppression and neurodevelopment after neonatal herpes.

Area of Science:

• Neonatal infectious diseases
• Neurodevelopmental outcomes
• Antiviral therapy

Background:

• Neonatal herpes simplex virus (HSV) disease survivors often experience poor neurodevelopmental outcomes and recurrent skin lesions.
• Current treatment strategies have limitations in preventing long-term sequelae.

Purpose of the Study:

• To evaluate the efficacy of suppressive oral acyclovir therapy in improving neurodevelopmental outcomes for infants with neonatal HSV disease.
• To assess the impact of acyclovir suppression on preventing cutaneous recurrences.

Main Methods:

• Two parallel, double-blind, placebo-controlled studies enrolled neonates with HSV disease (CNS involvement or skin/eye/mouth involvement only).
• After initial parenteral acyclovir, infants were randomized to 6 months of oral acyclovir suppression or placebo.
• Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant Development at 12 months.

Main Results:

• Infants with CNS involvement receiving acyclovir suppression showed significantly higher mean Bayley mental-development scores at 12 months compared to placebo (88.24 vs. 68.12, P=0.046).
• A trend towards increased neutropenia was observed in the acyclovir group (P=0.09).
• Data on cutaneous recurrences and outcomes for infants with skin/eye/mouth involvement were also collected.

Conclusions:

• Six months of oral acyclovir suppressive therapy improves neurodevelopmental outcomes in infants surviving neonatal HSV disease with central nervous system involvement.
• Acyclovir suppression is a promising strategy to mitigate long-term neurological deficits in this population.